Key result
Rocuronium-sugammadex significantly improved motor seizure modification scores (3.6 vs 3.0, p=0.003) and shortened respiratory recovery time compared to succinylcholine during electroconvulsive therapy.
Why the study?
Rocuronium with subsequent sugammadex was proposed as an alternative to succinylcholine to minimize convulsive motor activity during ECT, but its clinical recovery, quality, and side effect profile needed investigation.
Does rocuronium-sugammadex improve clinical recovery and ECT quality compared to succinylcholine in patients undergoing electroconvulsive therapy?
Observational (n=4)
No
Does rocuronium-sugammadex improve clinical recovery and ECT quality compared to succinylcholine in patients undergoing electroconvulsive therapy?
Absolute Event Rate: 3.6% vs 3%
p-value: p=0.003
Rocuronium-sugammadex provides better motor seizure modification and faster clinical recovery with fewer side effects compared to low-dose succinylcholine during electroconvulsive therapy.
May warrant evaluation in succinylcholine-intolerant ECT patients; leaves open superiority in randomized trials.
Introduction: The use of neuromuscular relaxants is needed in electroconvulsive therapy (ECT) to minimize the convulsive motor activity. Succinylcholine is the most useful and commonly available neuromuscular relaxant agent for ECT. However, rocuronium with subsequent use of sugammadex was proposed for ECT as an alternative to succinylcholine. Methods: A small case series of four patients with major depressive disorder recruited as part of a preliminary study is presented. The purpose of this study was to investigate the effect of a small dose succinylcholine (0.5 mg/ kg) and rocuronium (0.3 mg/kg)-sugammadex (4 mg/kg) complex on clinical recovery during ECT as well as ECT quality and the incidence of side effects. Results: Forty-eight ECT sessions were conducted in total in the post anesthesia care unit. The mean extent of motor seizure modification score was significantly higher in the group rocuronium-sugammadex (p=0.003). The mean time to resume spontaneous respiration and time to eye opening to verbal command were shorter following rocuronium blockade with 4 mg/ kg of sugammadex compared with succinylcholine (p=0.011 and p=0.028 respectively). Agitation and myalgia were significantly lower in rocuroniumsugammadex group (p=0.043 and p=0.01 respectively). Conclusion: This small case series study demonstrates the efficacy of rocuronium (0.3 mg/kg)–sugammadex (4 mg/kg) as an alternative to succinylcholine (0.5 mg/kg).
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MD et al. (2022) conducted an observational in Major depressive disorder (n=4). Rocuronium-Sugammadex vs. Succinylcholine 0.5 mg/kg was evaluated on Extent of motor seizure modification on a five-point scale (p=0.003). Rocuronium-sugammadex significantly improved motor seizure modification scores (3.6 vs 3.0, p=0.003) and shortened respiratory recovery time compared to succinylcholine during electroconvulsive therapy.
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